"The odds of re-presentation increased three-fold for people who were homeless compared to those living in stable accommodation."

Study after study proves that those without homes, the mentally ill and those who abuse drugs often use the ER as their primary source of treatment for ailments. It is an expensive trip, takes up preciously scarce hospital resources, making it more difficult for those with real emergencies to obtain care, and ultimately the costs are passed on to those of us with insurance as hurting hospitals try to recoup costs the only way they can.... My boss and I are currently in the planning stages of starting a pilot program with a local hospital that will hopefully begin recouping some of the costs associated with "indigent" patients. We think there is great promise in our approach and we will know within the next 3-4 months whether we are correct in our assumptions. If things go as planned, we believe we could save hospitals hundreds of thousands of dollars yearly. I doubt we'll ever see that translated into a lower insurance premium for any of us, but perhaps it'll take insurance companies a little longer to justify raising our rates once again.... Hey, we can dream, can't we? Public Health; Study findings from University of Melbourne provide new insights into public health Anonymous. Health & Medicine Week. Atlanta: Apr 7, 2008. pg. 2175

2008 APR 7 - (NewsRx.com) -- "People who have complex health care needs frequently access emergency departments for treatment of acute illness and injury. In particular, evidence suggests that those who are homeless, or suffer mental illness, or have a history of substance misuse, are often repeat users of emergency departments," researchers in Melbourne, Australia report.

"The aim of this study was to describe the socio-demographic and clinical characteristics of emergency department re-presentations. Re-presentation was defined as a return visit to the same emergency department within 28 days of discharge from hospital. A retrospective cohort study was conducted of emergency department presentations occurring over a 24-month period to an Australian inner-city hospital. Characteristics were examined for their influence on the binary outcome of re-presentation within 28 days of discharge using logistic regression with the variable patient fitted as a random effect. From 64,147 presentations to the emergency department the re-presentation rate was 18.0% (n = 11,559) of visits and 14.4% (5,894/40,942) of all patients. Median time to re-presentation was 6 days, with more than half occurring within one week of discharge (60.8%; n = 6,873), and more than three-quarters within two weeks (80.9%; n = 9,151).

The odds of re-presentation increased three-fold for people who were homeless compared to those living in stable accommodation ( adjusted OR 3.09; 95% CI, 2.83 to 3.36). Similarly, the odds of re-presentation were significantly higher for patients receiving a government pension compared to those who did not ( adjusted OR 1.73; 95% CI, 1.63 to 1.84), patients who left part-way through treatment compared to those who completed treatment and were discharged home ( adjusted OR 1.64; 95% CI, 1.36 to 1.99), and those discharged to a residential-care facility compared to those who were discharged home ( adjusted OR 1.46: 95% CI, 1.03 to 2.06). Emergency department re-presentation rates cluster around one week after discharge and rapidly decrease thereafter. Housing status and being a recipient of a government pension are the most significant risk factors," wrote G. Moore and colleagues, University of Melbourne.

The researchers concluded: "Early identification and appropriate referrals for those patients who are at risk of emergency department re-presentation will assist in the development of targeted strategies to improve health service delivery to this vulnerable group."

Moore and colleagues published their study in BMC Public Health (Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery. BMC Public Health, 2007;7():320).